Burden of osteoporotic fractures increasing in Africa and Middle East
Gathering data from 17 countries in the region as well as Turkey, ‘The Middle East & Africa Regional Audit’ is a landmark report examining epidemiology, costs and burden in individual countries as well as collectively across the region. The report was launched at the close of the 1st Middle East and Africa Osteoporosis Meeting, with a statement by Abdullah bin Sougat, Secretary of State for the office of His Highness Sheikh Hamdan Bin Rashid Al Maktoum, Deputy Ruler of Dubai.
A major increase in fractures is predicted for the region as a whole. In the Middle East, a predicted demographic explosion in the number of people over the age of 50 will take place in the coming decades. By 2020 it is expected that 25% of the population will be over the age of 50 and by 2050 this will rise to 40%. In Lebanon, Jordan, and Syria, this means that the number of hip fractures is projected to quadruple by 2050.
An alarming finding from the report shows that solid epidemiological research on osteoporosis and fracture incidence, and related relevant outcomes, is scarce at best. The Lead Author of the report, Professor Ghada El-Hajj Fuleihan, Director of the Calcium Metabolism and Osteoporosis Program, and WHO Collaborating Center for Metabolic Bone Disorders, at the American University of Beirut, commented, “This report reveals that a great research gap needs to be filled. Published data on incidence rates for hip fractures are only available for Iran, Kuwait, Saudi Arabia, Lebanon, Morocco and Turkey.
Furthermore, access to densitometry and care was limited in many countries, and reimbursement for diagnostics and therapeutics varied widely”. One of the primary recommendations of this report is the need for more research to gather the necessary evidence that would aid health authorities to develop comprehensive healthcare policies at all levels.
Due to economic development, non-communicable diseases have become the leading cause of mortality and morbidity in the region, yet osteoporosis has been identified as a national health priority in only three countries in this report and national osteoporosis treatment guidelines are available in only five countries.
As well DXA technology, considered the gold standard for measurement of bone mineral density, is not widely available or available only in urban centres in many cases. Furthermore, the level of awareness of osteoporosis among primary healthcare professionals is estimated as poor to medium in many countries. Education and lifestyle prevention programmes for the general public, measures which could help stem the rising tide of fractures in the coming decades, are also seriously lacking.
Widespread vitamin D deficiency and low calcium intake may be in part responsible for the alarming increase in osteoporosis. The prevalence of hypovitaminosis D is one of the highest in the world, and has been estimated to range between 50-90% in many countries and across all age groups, despite ample sunshine in the region.
Dr. med Gemma Adib, first author of the report and General Secretary of the Pan Arab Osteoporosis Society, stated “Vitamin D is an essential component of bone health and a relatively inexpensive way to decrease fracture risk. It is essential that the region develops vitamin D supplementation strategies based on local data for at-risk groups.”
For the individual, fragility fractures result in great suffering, disability as well as loss of productivity and quality of life. Fractures also represent an enormous burden for healthcare systems. Older people who suffer hip fractures are often faced with long-term disability that results in loss of independence and higher risk of death. Mortality rates after hip fracture may be higher in the Middle East and Africa than those reported from Western populations. While such rates vary between 25-35% in Western populations, preliminary studies have shown that these rates may be as high as 2-2.5 fold higher in certain populations within this region.
IOF President Professor John A. Kanis spoke at the launch of the Audit and commented, “Despite the severity of the problem, osteoporosis is being dangerously ignored as it competes with other diseases for scarce healthcare resources and recognition. Notwithstanding the burden of fragility fractures, osteoporosis remains greatly under diagnosed and under treated, and both health professional training and public awareness is sub optimal in most countries in the region. The result is premature death for many hip fracture sufferers, immense personal suffering, lost productivity and long-term dependence on family members.”
The International Osteoporosis Foundation joins local osteoporosis societies throughout the region to urge immediate government action to help prevent the rising tide of fractures and their profound socio-economic impact on millions of people and communities throughout the Middle-East and Africa.
View the Middle East and Africa Regional Audit published by the International Osteoporosis Foundation (IOF), the report is available below: